Supporting Statement - 0013

Supporting Statement for Form SSA-8-F4,

Application For Lump-Sum Death Payment

20 CFR 404.390-404.392

OMB No. 0960-0013

A. Justification

1. Introduction/Authoring Laws and Regulations

Title II of the Social Security Act (the Act) provides for payment of a lump-sum death payment (not to exceed $255) upon the death of an insured individual. Section 202(i) of the Act explains the conditions of eligibility for this payment, including the filing of an application. Regulations at 20 CFR 404.390-404.392 of the Code of Federal Regulations set the procedures and policies for implementing Section 202(i) of the Act. 20 CFR 404.392 requires the filing of an application by individual applicants to collect the information needed to determine eligibility for the payment. The SSA-8-F4 elicits the information about the applicant and the relationship to the deceased needed to make this determination of eligibility.

2. Description of Collection

The Social Security Administration (SSA) collects information on Form SSA-8-F4 to authorize payment of the lump-sum death payment (LSDP) to a widow, widower, or children as defined in Section 202(i) of the Act. Individual respondents complete the application for this one-time payment via paper form, telephone, or in-person interview with SSA employees. Respondents are applicants for the LSDP.

3. Use of Information Technology to Collect the Information

SSA collects the information electronically using the electronic Modernized Claims System (MCS) during personal interviews without completion of the paper application. Based on our data, we estimate approximately 95 percent of respondents use this electronic method of completion.

Electronic submission of application/form data through the Internet is an agency goal as an alternative means of doing business with SSA. However, the SSA-8-F4 cannot compete with other legislative mandates currently driving the use of SSA's limited funds. In addition, respondents complete the paper form only about 5 percent of the time as noted above. Finally, based on recurring Congressional proposals to eliminate the LSDP one-time payment, SSA expenditure of systems resources on a process with an uncertain program life would be counter to agency fiscal goals. Until Congress proposes SSA keep the LSDP indefinitely, we will not be using our limited resources to create an entirely electronic Internet version of the SSA-8-F4.

4. Why We Cannot Use Duplicate Information

The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.

5. Minimizing Burden on Small Respondents

This collection does not significantly affect small businesses or other small entities.

6. Consequence of Not Collecting Information or Collecting it Less Frequently

If SSA did not collect this information, we could not determine eligibility for LSDP, and, therefore, could not authorize payments to the widow, widower, or children of the deceased beneficiary. In addition, as we only collect this information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on March 4, 2010, at 75 FR 9992, and SSA received no public comments. The second Notice published on May 27, 2010, at 75 FR 29797. If we receive any comments in response to the 30-day Notice, we will forward them to OMB. SSA did not consult members of the public in the development or maintenance of this form.

9. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

10. Assurances of Confidentiality

SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.

11. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

12. Estimates of Public Reporting Burden

Approximately 587,000 respondents file the SSA-8-F4 annually.  Of this total 95% (557,650) use MCS and 50% of the MCS respondents use Signature Proxy (278,825). Signature Proxy is an alternative to the traditional pen and ink or “wet” signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimant’s behalf, without a signature. Under the Signature Proxy process, SSA obtains a “signature” from the respondent giving verbal consent for telephone claims. The estimated average response time for the SSA-8-F4 is 10 minutes for MCS and Paper responses, and 9 minutes for Signature Proxy responses, for 93,187 burden hours.

Collection Method	Number of Respondents	Estimated Completion time	Burden Hours
MCS	278,825	10 minutes	46,471
MCS/Signature Proxy	278,825	9 minutes	41,824
Paper	29,350	10 minutes	4,892
Totals:	587,000		93,187

The total burden for this ICR is 93,187 hours. This figure represents burden hours, and we did not calculate a separate cost burden.

13. Annual Cost Burden to the Respondents (Other)

The collection does not impose a known cost burden to the respondents.

14. Annual Cost To Federal Government

The annual cost to the Federal government is approximately $89,841. This estimate is a projection of printing and distribution costs for the information collection, and for collecting the information.

15. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms, (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise usable forms with expired OMB approval dates, avoiding Government waste.

18. Exception to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

2. Collection of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.